Depression - Some snippits

[Guest guest]

I am a dentist and I always bring patients medical records up to date when they come in on a recall. Many are on various anti-depressants and they almost look ashamed to tell me. I always say, "Great..that'll get you over the hump and you'll find things start to go better." The body language is amazing, their shoulders relax, they smile etc...

Sadly a wrong take is given to depression and "Talking your way through" is not on at all. I had a problem a few years ago and sadly the old Macho Canuck thing said ..hey I'm the guy who played hockey goalie for 25 years I can handle it...not true.A great story is this one I heard on a dental net.Imagine you are walking down the street and you see a friend set upon by a bully, you can go over and say "Hey Bill hang in there , you can beat him off.." Or you can help your friend and pull the bully off and both of you can handle the bully.The bully is depression, offering your encouragement is talking through it...your helping get the bully off is the appropriate medications. I've told this to many patients and they love the story :)Pass it on

I have clinical depression, have had it for as long as I can remember in my teenage thru adult life. My sister killed herself with prescription drugs. She'd also had shock treatments. I have not.I took different drugs when I needed them thru the years. When the Prozac drugs came out, there was help! Serzone works best for me. I can stay in control with that.I worked thru a bunch of stuff that was aiding the depression about a year ago. It was a horrible experience, crawling into myself like that. But I worked hard and succeeded in getting to the root of some things.Clinical depression is incurable. But thank God for the newer drugs. You have no idea how much I wish my sister could have gone on prozac 40 years ago. Perhaps she'd be alive today.Take care and best wishes.

This is another important point on this topic: "anti-depressants" are, in fact, used for more than just depression. For example:1) Tri-cyclic antidepressants are used (as Aisha has mentioned) in a variety of chronic pain and neuropathic pain syndromes.2) Panic and anxiety disorders often respond well to anti-depressants, often at lower doses than those required for depression. [Paxil is perhaps the best studied?]3) Obsessive-compulsive disorder [which is VERY biochemical; it has one of the lowest response to placebo of any psychiatric illness] is also treated with the SSRI's.4) PMS [or, in the new lingo "peri-menstrual dysphoric disorder", which is to distinguish it from just feeling 'witchy' at "that time of the month".] I believe Prozac just got approved officially for this indication (and they're even selling it under a different trade name: same chemical, different name. I suspect this is partly because of the 'stigma' of Prozac--it's nice to take a drug that is specifically FOR "PMDD"--and partly because they got a patent extension, I think.)5) Post-traumatic stress disorder (PTSD) as already mentioned6) There's also a high amount of co-morbidity of depression in illnesses like schizophrenia.7) Some medical conditions, such as hypothyroidism, can depress you. One treats the thyroid, but one should also treat the depression: so, this might be "secondary" depression, if one likes.All that being said, there _is_ RTC data for things such as "cognitive behavioral therapy" in depression which are about equivalent to using medication. [both are better than placebo, and both together are better than either separately.] Cognitive behavioral therapy, for those who don't know, is a short-term, out-come oriented form of psychotherapy. It's goal is to help people recognize the kind of thinking or perception errors which can perpetuate depression. For example, one could realize that whenever one contemplates a stressful situation, one anticipates the worst possible outcome. CBT aims to help patients recognize these self-destructive thought patterns, identify them for what they are, and use their own cognitive framework to "re-order" them. A popular and accessible book on the topic is Burn's "Feeling Good", which is available in paperback. There's also a workbook. The author is an MD psychiatrist, who worked with the pioneer in the field (Beck, I believe).For someone who's fairly depressed, however, it's pretty hard to summon the energy (much less the interest, will, attention span, etc) to use cognitive techniques without a LOT of support and reinforcement. I think if one sent most patients out with a copy of Burns, they'd be hard pressed to read it. I doubt they'd be able to summon the energy to go and buy it if you recommended it. Even talking about such issues would probably be difficult: everything's hopeless when you're depressed.Personally, I think the best approach is to start anti-depressants, and THEN work on potential cognitive approaches, insight into the disease and potential non-biochemical triggers, etc. as "the fog begins to clear".

I always explain to patients that these aren't "fire and forget" drugs; I want to see them regularly, but because they take a few weeks to work, I need them to "trust me" when I say that it is a disease, and we can treat it. Part of depression is not seeing reality or things clearly: often their family can collaborate this perspective.Depression is an illness that can ruin your life, your marriage, your kids, and even kill you. Thankfully, it can be treated and most people do quite well. It should not be self-treated, though, and one of the symptoms is an inability to assess oneself accurately, which makes self-treatment so problematical.